Massage and Psychotherapy: Mapping a Landscape

by Roz Carroll

[This paper was originally given as a talk at the AGM of Chiron Psychotherapists in November 1998. The audience was made up of body psychotherapists and biodynamic massage therapists and so the talk assumes a knowledge of this approach to therapy. For psychotherapists trained at Chiron contraversy around the use of touch in general, and biodynamic massage in particular, has been ongoing. This is in contrast to many body psychotherapy institutions where touch is a given; and in contrast to all the forms of psychotherapy where touch does not play a role. ]
I am going to speak tonight of the value and richness I find in using massage in psychotherapy. I am not going to present a balanced argument for and against it. I think biodynamic massage is in need of a voice to re-articulate its potential so I am going to share my own fascination with massage as a medium . I will also talk about some of the ways in which the technical difficulties it presents in a psychotherapy context can be handled creatively and therapeutically. I am mindful of the fact that transference itself, when first identified as a phenomenon by Freud, was seen as an obstacle to therapy. Nowadays, transference and countertransference are considered the very crucible of the transformative process.
I want to take the familiar metaphor of psychotherapy as a journey, and suggests that when I use massage, the client and I are exploring a landscape together . The landscape is both the client's bodymind and our relationship. However we chose to explore this landscape, I am aware that the surface is not the whole story, but the outerlayering which encompasses a deep structure. The client and I are having an experience together, and paradoxically, we are almost inevitably using very different maps, and even our compasses will disagree about which direction is north. This is the discrepancy between the client's expectations and fantasies about what will transpire, and my intention and interest in using massage. The degree to which we can together become conscious of that split, is the degree to which this process can deserve the name of psychotherapy. The value in using massage often lies precisely in meeting or even exposing the feelings underlying a fantasy. The client wants to be massaged and then in the actual encounter on the massage table we can explore the question, "so - how is it?"
Making conscious what is unconscious is of course a long and involved process and I am not suggesting that the client's splits can be worked through in massage alone. What I am suggesting is that we can undertake a kind of preliminary mapping. The main theme of my talk tonight is how this mapping process can provide co-ordinates, touchstones, which the client may still have available later along the road, as a reference point in the process of integration.
In a simplified version of a biodynamic model, the individual and the environment (which includes people) interact, and this process can be described as psychobiological self-regulation. What biodynamic theory does extremely well is describe how a human being manages or organises experience anatomically and biochemically. It offers both a model of healthy self-regulation and a description of pathology - how conflict, pain and experience which overwhelms the ego is encapsulated physiologically at a cellular and autonomic level. The dance of neurons firing, fluids rushing or congealing, the portals of the gut surrendering to pleasure or violently contracting, and splitting and parcelling up the charge throughout the systems of the body. Boyesen depicts both acute vegetative responses and the effects of chronic internal stress, with its resulting layers of sediment compressing weak structures with ever more rigid defences.
One of the determining characteristics of any self-organising system - be it a very simple organism, such as a star fish, or a complex one such as a human being - is the existence of feedback loops. Even with clients who have very strongly dissociated from their bodies, putting my hands on them can highlight in a very immediate way an aspect of their experience, even if its as basic as recognising that their feet are freezing cold, or they feel numb around the thigh. My presence with and through the touch, and my questions and comments, offer a form of feedback. The congruence or lack of it between the client's experience of his /her body and my perception is already a powerful barometer of an object relationship.
Now, there may be a very strong fantasy in the client wanting my touch to - for example - make everything all right, but if I hold my client with the nitty gritty of their actual experience, their awareness of sensation, of breathing pattern, of how present they are with me as I touch, then the layers which begin to unfold are usually of grief, irritation, rage, fear, disappointment, and so on. The fantasy and the actual sensation are split off fragments of the same experience. Of course there can be good feelings as well - of pleasure, connection, being held etc. Massage can help focus body awareness and I pay a lot of attention to enhancing the client's awareness of his/her body in the contact with me. I believe that body-awareness - the cohering of sense perceptions - is a fundamental building block for self-awareness, and ultimately, interpersonal and intrapsychic awareness.
Biodynamic massage offers tools for clearing the superficial debris from the energetic field in order to focus and amplify sensory detail of an impulse or movement of energy which may be barely discernible under layers of defence. It is a form of feedback, and can help the client differentiate and separate out different parts so they can have a sense of themselves and say things like - I don't feel connected to my legs, there's a lot of heat around my shoulders, my arms feel vulnerable, my head is buzzing.
The limitation of the biodynamic model, however, is that the individual as a self-organising system is conceived of as uncontaminated by internal objects. But we can add internal objects as a third factor in the loop. By internal object I mean a mental representation - usually unconscious - of an external figure of significance. It is in the nature of internal objects that they are going to be projected into or onto any available space. They can be externalised - projected onto a person, event or thing. Or internalised, introjected into the body. In using massage, there is the possibility of working with both aspects.
Internal objects can be projected onto the act of massage itself as a fantasy about what it implies. For example - massage is the laying-on of hands, massage is a theatre for cathartic performance, the massage table is an operating table. Such fantasies are usually unconscious but can be accessed through the client's associations to what is happening, and through the countertransference. The scenario, for which the massage table is a prop, usually implicates the role of the therapist. One client found herself thinking of a nursery rhyme, "Ha, ha, ha, he, he, he. I'm the gingerbread man - you can't catch me!" So we explored that and she realised that underneath the mischievous sense of hiding and running was the fear of being moulded and controlled by me as the baker.
The transference may be directly or indirectly experienced by the client. With one client, a young professional woman whom I shall call Elizabeth, I have explored in detail the theme of torture via her experience of her body in the transference with me. She originally came to me for massage, although we soon changed to a psychotherapy contract, and at the beginning she found it hard to identify and name sensation. Then, in our twelfth session I was doing some very modified deep draining - there was peristalsis and some deep breaths, but I had the sense of invading her. And I said, "even though I can't see it, I feel as though you're trembling." She said there was a pain shooting up to her head and she had an image of a flashing light. And so I asked, "how far would you let me go before you said stop?" and she said a bit shakily, "you've got my best interests at heart". To which I replied, "that's the theory, but your body suggests otherwise". I also connected this interaction with me to what was happening in her life with a friend who she was having sex with despite the fact that it wasn't what she wanted.
A few sessions later, when I had one hand on her shoulder and another on her elbow, she became aware of feeling pinned down, and having a panicky impulse to push me out of the way. She had the image of a torture chamber and me as her mother intent on restricting or punishing any feeling or sensation in the body. We have pursued the ramifications of this both on and off the massage table. She has identified the feeling of torture with being attached to a mother whom she hates but is unable to separate from. Clearly massage is associated on one level with violent repression. The flip side of it is a powerful fantasy of me as a psychic surgeon who could operate on her - to remove her mother, who is imagined as inside her womb. There came a point about six months ago when we stopped massage, as I said to her, "why do you want to keep torturing yourself?" and we began to look at the desperation which pushed her to keep re-enacting her conflict. The experience of torture often manifested for Elizabeth as an image of cruelty with lines from a love song echoing in her head as a kind of mocking accompaniment. These discrepancies between image and tone, sensation and fantasy, the client's words and their body signals are extremely important for understanding the transference and levering it up into consciousness. These splits are not just a signpost to the therapist, but play a crucial role in helping the client experience incongruence and conflict between parts of themselves.
I want to talk now very briefly about introjection and what I am calling the somatic metaphor. A somatic metaphor is an energetic pattern in the body which both symbolises and expresses an unconscious conflict. It can be an illness, or a set of symptoms, pain, tension etc. or just a fleeting energetic self-perception. It can be acute - a metaphor of the moment; or chronic, a metaphor which permeates the clients' life. For example Elizabeth would experience a violent spasm of her abdominal muscles when she was getting a feeling that her mother wouldn't approve of. The spasm is the introjected mother putting the boot in. The metaphor is the client's attempt to comprehend, or reconcile the conflict between internal objects, and to maintain stability in existing relationships. It represents something outside awareness, and it is only through reflection, or the intrusion into consciousness of pain, limitation, or indeed a diagnosis of illness that it begins to be known.
Client or therapist may first glimpse the metaphor through noticing a phrase like, "I haven't got a leg to stand on", "my heart's not in it", or through focusing on sensory detail in the body. For example, one client described her eyes "as standing in front of my heart to protect it". The meaning in terms of object relations may need some elucidation. In the last example - the sense of the eyes standing guard is powerful, and invites questions such as, who does the heart represent? who or what does it have to be protected from? Sometimes the metaphor may not explicitly include the body. For example, with one client I noticed that she used the phrase, "all or nothing" in reference to what she wanted in a relationship. This translated in the massage into a demand for total fulfilment of all needs. The fantasy in the demand actually masked the anguish of being with her frustration. As I massaged her neck, she got in touch with an animal sense of her jaw, with a deep desire to bite and suck, whilst also hating me for not doing more.
Naturally, this exploration has many dimensions. I may make use of my structural knowledge of the body, and my understanding of early development, and of character, in quite a technical way to extend the mapping process. Let me give an example : "I don't know which way to turn". The client may use this phrase as they are talking, or may be it will occur to me as I am with them. Perhaps I notice the client's discomfort or restlessness on the table, as they turn their head this way, and that. I may put my hands on their back. The client becomes aware of tension in and around the spine. As we stay with it, it may become a sense of turmoil, of trying to escape, of contorting this way and that. At this point it can be tempting for the client to just writhe around and attempt to get rid of that unbearable feeling of deep tension. I would probably encourage the client to slow this down a bit so we can both get a feel for exactly how the spine is twisting.
is it primarily led by the head?
is it initiated from the neck?
how are the shoulders/ elbows involved?
is the back flexing and extending?
or is it moving laterally?
or is it a combination?
This is where experience, the capacity to contain the client, and the ability to focus on sensory detail is crucial. There can be many layers to a pattern, and sometimes clients present quite a tangle of impulses and defences. The therapist needs to hold that chaos, and have the clarity to unpick it. So, lets go back to the client twisting on the table. Considering the client's movements and my own countertransference response, I would be wondering:
are these movements in the back related to a birth process ? (Activated birth reflexes always have a symbolic significance which relates to the present. I need to consider whether I am standing in for a very early part object, for example, a suffocating womb or an unyielding cervix.)
or is it to do with rooting reflex ? (The rooting reflex is a primitive reflex which orients the baby towards the breast. Nonreinforced, unintegrated, extinguished and overstimulated reflexes are all potent carriers of relationship dynamics. For example, in the Robertson video of the little boy John who is left in care whilst his mother goes into hospital to have a baby, we see his progressive emotional deterioration. When she returns, he turns his head away from her, exhibiting a sort of 'anti-rooting' reflex - what in Jane Austen's day they used to call "cutting someone dead".)
or perhaps there's a sense that someone's on the client's back?
or are they just recoiling from their own instinctual energy? (hysterical arch)
I am very interested in space and dimension, the vector of movement of energy. Is the object coming from the side? or from above, or up from below? This preliminary mapping is followed through in my process with questions such as escape from what object? is this turning away from the bad breast? or from a tyrannical father? or is it precisely that the client is caught between the two? is the father on the back and the mother in the face?
How and when I would explore this with the client verbally, how much I would relate directly to our relationship, would depend completely on where the client was with the process, and in the relationship, and the kind of vocabulary and concepts they have for thinking about it. It varies enormously. Some clients are very sophisticated and can readily reflect on quite intense, primitive behaviour. With other clients I would say very little, but I would hold the information in my awareness. The most primitive level of object relating embodied in the system may be just glimpsed at this stage, but its there as a marker that both the client and I can refer to. Perhaps the client finds then that they are not wanting massage, and we can look at how they experience that or recognise it. Often its deeply unconscious - something has been touched and the client will want to find a different level to interact with me.
In using massage I am working on different levels simultaneously and moving through different modes all the time. Reflecting back and forth, noticing vegetative changes, and allowing my hands the possibility of free associating and, at the same time, finding ways to interact with the client verbally, or not. The more I work with massage, the more I trust my impulses to bring forth elements which may be buried in the relationship. Sometimes the techniques are just a way of having a conversation. Often what I 'do' is minimal because what I'm interested in is the encounter. If I am very active, that in itself is a countertransference response. For example, with a client who is very restless and defends intensely against relaxation, I recently did a very physically vigorous work out - vehemently pushing and rocking and stretching and kneading. I was aware that I was allowing her violent frustration to manifest (in a modulated way!) externally through me 'doing' it back to her. It enabled her to laugh from her belly and feel the relief - for a short while - of not having to contain it, and thus to know, experientially, the strain of having held it. I didn't say much during the session, but at the end commented that what I had done was more congruent with how she felt inside .
Biodynamic massage is sophisticated enough to address both the actual physicality of the body and its energetic reality. The energetic or subtle body is the connecting link between the physical body and the body as a symbolic or fantasy space. If I can relate to that fantasy space with my language as well as my hands, if I can touch something and help the client name it, then I believe there is a process of integration happening, or at least an attention to the dis-integration.
I want to keep the definition of somatic metaphor very broad, but in using it as a framework, I take into account three key criteria. Firstly: it needs to be recognisable as a set of feelings and sensations Secondly: it has to have a meaning that can be captured easily in a short phrase. Thirdly it has to give form or sense to a relationship which exists in the past and the present, internal and external. In other words, it has to be embodied, embedded in language, and encompassing a dynamic relationship.
In my experience though the client may suffer with the limitations illness and pain impose on their life, until they have an embodied sense of a dynamic, they can't really make use of insight. Ultimately the somatic metaphor needs to be experienced by the client on all three levels - sensation, symbol and relationship. For it to be recognised and integrated by the ego can, of course, take years. Massage can contribute to mapping major landmarks but it does not constitute a complete process.
What I hope I have been able to evoke for you tonight is how I think massage can be of value in making the somatic metaphor more graphic, more readily identifiable, and more accessible. I want to conclude with two contrasting metaphors for my use of massage in psychotherapy. One is of massage as a vehicle, a means of exploring a landscape. The other is of an animal tracking a scent, nose close to the ground...........
I will leave you with this paradox.
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